You have chronic pain in your teeth. Any action that requires concentration (e.g., maintaining a spell) requires a successful DC 10 + (IE) Constitution saving throw per round to maintain concentration. The pain makes talking difficult, causing a penalty of −(IE) on social Charisma checks, and spells with a verbal component require a successful DC 8 + (IE) Dexterity check to cast successfully. Because this also causes eating difficulty, you must succeed on a DC 8 + (IE) Constitution saving throw to maintain concentration while eating or drinking. Because you’re used to managing pain, even though this doesn’t reduce the experience of pain, you have a +(IE) bonus to saving throws against psychic damage.

Real-world Examples

Gingivitis, Tooth Decay, Periodontitis, Atypical Odontalgia, Charcot-Marie-Tooth Disorder, Amelogenesis Imperfecta

Assistive Options

Sucking on a piece of ice can reduce the IE by 1 while the ice remains in the mouth and wears off 1 minute after the ice melts or is removed.

Magical Assistance

A healing spell can target the teeth and reduce the IE by 2 for 1 hour instead of regaining hp.

You are missing (1d20+1d12) teeth. While this has some mild cosmetic effects, it has no effect on game mechanics besides needing to adjust your diet to softer foods.

Real-world Examples

Anodontia, Hypodontia

Assistive Options

A doctor can make a set or partial set of ivory or bone dentures for 1 gp per tooth and 2 teeth per day of work, requiring a successful DC 8 Wisdom (Medicine) check. They’re prone to falling out while eating or during a barbarian Rage, requiring a successful DC 8 Dexterity saving throw to keep them in, and they must be replaced annually.

Your teeth are not within the range of shapes expected for your ancestry. Choose or roll on the following table. This trait does not have an IE. All of these give you a −1 penalty on disguise attempts.

• Buck Teeth. Your 2 top incisors are larger than usual and extend past your bottom lip when your mouth is closed. You can chew through materials as hard as wood, but you have a −1 penalty on Charisma (Persuasion) checks.
• Fangs. You have venomous fangs that allow you to make an unarmed bite attack. The bite causes 1 piercing damage, and the target must succeed on a DC 10 Constitution saving throw, taking 5 (2d4) poison damage on a failed saving throw, or half as much damage on a successful one. You have a −2 penalty on all Charisma (Persuasion) checks due to many people’s fears of snakes, and you’re likely to be mistaken for a snake person or, more likely, a vampire. This gives you a +1 bonus on Charisma (Intimidation) checks.
• Oversized. Your teeth and jaw are much larger than expected, giving you a grimacing resting face. This difference causes discomfort in social situations and gives you a −1 penalty on all social Charisma checks.
• Sabertooth.You have fangs that extend down to the bottom of your neck like a walrus or smilodon. You can use them to make an unarmed bite attack causing 2 (1d4) + Strength modifier piercing damage. Because this affects your speech, you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls, and when learning a new spell with a verbal component, it takes 1.5 times as long to copy it into your spellbook as usual.
• Shark Teeth. You have several rows of sharp teeth in your mouth. You can make an unarmed Bite attack for 3 (1d6) plus your Strength modifier piercing damage. This affects both your appearance and your speaking ability, causing a −1 penalty on all Charisma (Persuasion) checks but a +1 on all Charisma (Intimidation) checks.
• Tusks. You have tusks on your lower jaw that extend halfway to your eyes, but unlike those of Orcish ancestry, your jaw is not designed to assist with the oversized teeth. (10 percent have tusks on both jaws like an Oni.) Because this affects your speech, you must modify spells with verbal components to work within your verbal range, so you cannot use spell scrolls, and when learning a new spell with a verbal component, it takes 1.5 times as long to copy it into your spellbook as usual.
• Undersized. Your teeth are smaller than expected for your ancestry. While this has some mild cosmetic effects, it has no effect on game mechanics.

Real-world Examples

Hyperdontia, Retained Primary Teeth

Assistive Options

Short of extracting the teeth and replacing them with dentures, these have no mundane assistance.

Your teeth are a color not within the range typically associated with your ancestry. (Use a random color generator such as https://www.random.org/colors/hex to determine the color.) This trait does not have an IE. Because it may be distracting to others or require you to talk such that your teeth are hidden, you have a −1 penalty on Charisma (Persuasion) checks when speaking within 10 feet of the target.

Real-world Examples

Rickets, Celiac Disease, Porphyria, Dead Tooth

Assistive Options

This trait is managed by a large mustache and/or covering teeth with lips when talking.

Your legs get weak due to muscle tone or neurological failure. This reduces your movement speed by (IE) × 25 percent without assistance. Consider the Strength attribute to be (IE) × 3 less for all Strength checks involving leg strength. Every round spent standing requires a successful DC 8 + (IE) Constitution check, the DC increasing by +(IE) each round. Failure results in you immediately needing to sit or be prone.

Real-world Examples

Slipped Disc, Guillain-Barré Syndrome, Multiple Sclerosis, Peripheral Neuropathy, Parkinson’s Disease, Myasthenia Gravis, Amyotrophic Lateral Sclerosis, Down Syndrome

Assistive Options

Braces, wheelchairs, or other mobility devices are helpful. Leg braces reduce the IE by 1 while worn but must be removed during long rests to gain the benefits of the rest. Adding crutches with the braces reduces the IE by an additional 1 but must be held to move during combat, requiring creative attack strategies.

Your legs move uncontrollably, giving you a −(IE) penalty on Dexterity (Acrobatics) checks and Dexterity (Stealth) checks.

Real-world Examples

Pathologic Myoclonus, Restless Leg Syndrome, Huntington’s Disease, Amyotrophic Lateral Sclerosis, Hyperreflexia

Assistive Options

During a short or long rest, succeed on a DC 8 + (IE) Constitution saving throw to reduce the IE by 1.

Your toes, ankles, knees, and/or hips (Roll 1d8 (IE) times, 1–4 = right side; 5–8 = left side) are difficult or impossible to move without extreme pain if at all. You have a −(IE) penalty on any action that would use that joint, including attack rolls. Your daily walking distance is reduced by (IE) × 20 percent.

Real-world Examples

Arthritis, Fibromyalgia, Multiple Sclerosis, Stiff-Person Syndrome, Dystonia, Patellofemoral Syndrome, Plantar Fasciitis

Assistive Options

Spending (IE) hours per day (15 minutes at a time spread throughout the day) stretching the stiff muscles will reduce the IE by 1 until the next stretching session is due. Mobility aids can assist with the daily walking distance penalty. Spending one hour swimming or bathing in warm flowing water will reduce the IE by 1 for 2d6 hours.

Magical Assistance

A healing spell can target the lower body and reduce the IE by 2 for 1 hour instead of regaining hp.